PubMed Health⌕ Search

Biomedical subjects

F Sebening

Publications and source records attributed to F Sebening.

At least 55 records · Page 3Linked to original sources
PubMed1989

A mediastinal tumor simulated by a sacculated aneurysm of the azygos vein.

A rare case of a true idiopathic aneurysm of the azygos vein is reported. A 54 year old female with signs of obstruction of the superior caval vein was submitted to a chest X-ray-examination. It showed a giant mass in the right chest with a diameter of 12 cm. Mediastinal phlebography, CT and NMR-scans of the thorax yielded an aneurysmatic tumor, which seemed to originate from the superior caval vein near to the right atrium. With the clinical diagnosis of an aneurysm of the superior caval vein a right thoracotomy was carried out. Intraoperatively we found a sacculated aneurysm of the azygos vein near to the superior caval vein. Despite of extensive, clinical and radiographic investigations no cause for the aneurysm could be detected. This is one of the very rare cases of congenital aneurysm of the azygos vein.

Aneurysm↗
PubMed1989

[The significance of heart rate for stress hemodynamics following heart transplantation].

Since 1985, orthotopic heart transplantation had been carried out in 20 patients. Seventeen patients are still alive. 341 +/- 156 days after cardiac transplantation hemodynamics at rest were normalized. Left ventricular ejection fraction at rest and during exercise was within normal ranges for all patients except one. During symptom-limited bicycle exercise (121 +/- 35 Watt), pulmonary capillary wedge pressure (PCP) and right atrial pressure (RAP) increased to unphysiological high levels (PCP: 8.2 +/- 2.7 mmHg at rest, 19.1 +/- 4.9 mmHg at exercise; RAP: 4.1 +/- 2.3 mmHg at rest, 12.1 +/- 3.9 mmHg at exercise), whereas cardiac index was elevated to a normal level (3.6 l/min.m2 at rest; 6.9 l/min.m2 at exercise). Increase in heart rate, however, was subnormal (from 90 +/- 13/min at rest to 122 +/- 15/min at exercise). To examine the influence of heart rate on hemodynamics, in 8 patients with normal tricuspid valve function, heart rate was gradually increased by atrial stimulation during continuous exercise; PCP maximally could be reduced from 19.1 +/- 4 mmHg to 10.8 +/- 2.7 mmHg (p less than 0.01) at an optimum heart rate of 139 +/- 9/min. Reduction of RAP was by far less pronounced and normalization could not be achieved (from 12.2 +/- 3.7 mmHg to 9.5 +/- 3.4 mmHg, p less than 0.01), suggesting an impaired right ventricular function. By atrial stimulation stroke volume was reduced from 109.8 +/- 17.7 ml to 91.8 +/- 14.2 ml (p less than 0.01). These results indicate that, at exercise, the denervated transplanted heart, to a large extent, increases cardiac output by means of the Frank-Starling mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1988

[Rupture of the ventricular septum following posterior wall infarction: echo- and Doppler echocardiography diagnosis with pressure determination].

In the postinfarct ventricular septal rupture, an early surgical intervention improves prognosis. A rapid and accurate diagnosis is necessary. A 56-year-old patient was admitted to the hospital with a Q-wave posterior myocardial infarction. Auscultation suggested a ventricular septal defect. Neither M-mode nor the two-dimensional echocardiography with apical four- chamber view could confirm the ventricular septal defect. Only the subcostal view showed a basal ventricular septal defect, which was sometimes covered by the septal leaflet of the tricuspid valve. With the continuous wave Doppler, a left-to-right shunt on the ventricular septum could be registered and the pressure in the right ventricle could be measured. Catheterization confirmed the diagnosis of a basal ventricular septal defect with the associated pressure characteristic. The basal ventricular septal defect was successfully closed with a patch. The high accuracy of the continuous-wave Doppler, which is superior to M-mode and two-dimensional echocardiography, was confirmed by this report. Pressure measurement in the right ventricle by continuous wave Doppler also provides a non-invasive diagnostic method that can be used at the bedside.

Blood Flow Velocity↗
PubMed1987

Estimation of the operative risk of mitral valve replacement by multivariate logistic regression analysis.

The knowledge of factors determining the risk of postoperative myocardial failure (MF) should allow a more rational approach to the timing and the management of mitral valve replacement (MVR). Using multivariate logistic regression analysis the influence of 41 preoperative and perioperative variables on MF was assessed in a training group of 353 consecutive patients undergoing isolated primary MVR between 6/76 and 12/82. Early MF mortality was 4.2%. Strongest independent preoperative predictors of MF were advanced NYHA functional class (p less than 0.001), hepatomegaly (p = 0.001), and reduced body weight (p = 0.01). Amongst preoperative and perioperative variables independent determinants of MF were NYHA functional class (p less than 0.001), hepatomegaly (p = 0.002), hypotension during extracorporeal circulation (ECC) (p = 0.005), body weight (p = 0.007), ECC duration (p = 0.008), female sex (p = 0.061) and the absence of cardioplegia (p = 0.065). From the combination of these determinants estimates of the probability of MF were calculated and adjoined to low or high risk by means of an optimum cutoff point. The sensitivity of this test performed before and after operation was 0.80 and 0.93, the specificity 0.92 and 0.94, respectively. The reliability of this prognostic test was prospectively evaluated on data of 107 consecutive MVR patients between 1/83 and 12/84. The observed diagnostic characteristics of the test group were comparable to those predicted from the training group. Multivariate logistic regression analysis selects independent determinants, estimates the risk of MF or other modes of postoperative events and identifies patients with low or high risk with a definable validity as an objective aid for medical decision-making.

Bioprosthesis↗
PubMed1986

Interrupted aortic arch: natural history and operative results.

The chances of survival for patients with interruption of the aortic arch depend mainly on early recognition and medical treatment before symptoms of cardiogenic shock appear, and specifically on early operative repair after the exact diagnosis has been established. Accurate angiography with visualization of the interrupted aortic arch and delineation of associated cardiac malformations is of prime importance for the surgical management and prognosis. Among our 36 patients with interrupted aortic arch, 27 were operated on. The operative mortality in 22 patients with associated ventricular septal defect (VSD) and persistent ductus arteriosus (PDA) was reduced from 43% (in seven patients seen up until 1979) to 7% (in 15 patients seen since 1980). One patient with interrupted aortic arch type C and another infant with associated truncus arteriosus were successfully corrected on day 9 and day 17 of life, respectively. In the patients with associated VSD and PDA as well as in the one patient with associated truncus arteriosus, the primary correction--direct anastomosis of the interrupted segments without prosthesis and VSD closure and in the case with truncus, the additional positioning of a valve-bearing allograft conduit from the right ventricle to the pulmonary artery--has been more successful than a two-step approach with initial pulmonary artery banding.

Aorta, Thoracic↗
PubMed1985

[Reconstruction of the right ventricular outflow tract with xenogeneic or allogeneic valve-bearing conduits].

From April 1974 to February 1985 131 patients were operated for reconstruction of the right ventricular outflow tract with 147 valve-carrying conduits. 79 were xenogenic (XC) and 68 sterilized and preserved allogenic (AC) conduits between right heart and lung in the following heart defects: DOLV 2, DORV 6, Fallot 24, pulmonary atresia 33, TGA, VSD and pulmonic stenosis 20, single ventricle 7, tricuspid atresia 10 and truncus arteriosus 41. Mean age was 6.6 and 5.2 years of age. The operative mortality was 13.6%. 11 more patients died later--2.0 months to 2.5 years postoperatively. 16 patients were reoperated (change of the conduit). The observation time is now 5 years in the XC-group and 1.4 years in the AC series. Up to now no dysfunction in the AC-group could be seen.

Adolescent↗
PubMed1985

Ten years experience with povidone-iodine in heart surgery.

Ten years experience with povidone-iodine (PVP-I) (10%) ('Beta-isodona') in 7566 patients undergoing open-heart operations in the German Heart Centre, Munich, is reported. Povidone-iodine was used pre-, intra- and postoperatively for skin and wound disinfection according to a regime introduced more than 10 years ago and retained unchanged until today. The incidence of minor, superficial wound healing defects was 5%, whereas severe, deep sternal or retrosternal infections occurred in 0.5% of all patients. Superficial infections are no risk to the patient and can be treated successfully with local application of PVP-I. Deep infections, however, are associated with a mortality of about 40% despite the use of antibiotics and continuous wound irrigation with PVP-I (0.5%). Many factors contribute to the risk of these infections and only meticulous observation of aseptic and surgical technique, the prophylactic and therapeutic use of highly effective antibiotics, as well as the exclusion of sources of exogenous bacteria, can further reduce the incidence of these complications.

Anti-Bacterial Agents↗
PubMed1985

Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.

Bioprosthesis↗
PubMed1985

Heart transplantation: limitations and perspectives.

The intrinsic limitations of heart transplantation are the restricted availability of donated organs, patient selection, hospitalisation costs, and the limited capacity of cardiac surgery clinics. With a better understanding of organ transplantation and heart transplants in particular, both by the general public and the medical profession, improvements in the care of patients with terminal myocardial disorders seem to be possible with heart transplantation. The one year survival rate for heart transplants is 80%. The success of the treatment is determined by the hemodynamic capacity of the transplanted organ, security against rejection reactions, effects of cellular transplant reactions, and side effects of immunosuppression. Within defined limits heart transplantation is the best standardised method of treatment for terminal myocardial failure.

Adolescent↗
PubMed1984

[Embolectomy in patients with pulmonary embolism without symptoms of shock].

The therapeutic spectrum for the management of patients with pulmonary embolism includes either drug therapy with anticoagulants or with thrombolytic agents, or embolectomy. The indications for either form of therapy are not always clearly separable, but, in general, surgery is reserved for those patients with massive embolism and shock. Large, mobile thromboemboli located centrally, either within the right heart or in the main pulmonary artery, bear the risk of further, possibly fatal, embolisation that might actually be increased by thrombolytic therapy. Therefore, demonstration of such a thromboembolus seems to justify the decision for prompt surgical removal even in the absence of shock as exemplified in the two cases presented here.

Aged↗
PubMed1984

[Surgically correctable complications of myocardial infarct].

Coronary artery bypass grafting is a straightforward solution to the problem of myocardial ischemia secondary to coronary artery disease. More recently, the complexities of complications following myocardial infarction have been elucidated with respect to various aspects. Disastrous sequelae, such as rupture of the ventricular septum, the left ventricular wall and the papillary muscle, impose many intricacies on the inevitable surgical treatment; this form of cardiac surgery is still a tour de force. Life-threatening ventricular tachycardias due to transmural myocardial infarction and/or left ventricular aneurysm remain a surgical challenge. An attempt is made to delineate the current state of surgery for acute and chronic complications of myocardial infarction.

Aged↗
PubMed1984

Tetralogy of Fallot. Development of hypoplastic pulmonary arteries after palliation.

Thirty-one patients with tetralogy of Fallot were studied angiographically before and after palliation with Blalock-Taussig operation (n = 9), Brock operation (n = 12), or enlargement of the right ventricular outflow tract with extracorporeal circulation (ECC) (n = 10). The relative diameter of the pulmonary vascular ring (PVR), pulmonary trunk (PT), and right and left pulmonary arteries (RPA, LPA) were measured before and 24.8 +/- 20.9 months after palliation. Using correlation analysis, the magnitude of growth of the pulmonary artery system was inversely related to its initial size. Mean pressure in the pulmonary artery after palliation as well as the period between date of surgery and recatheterization did not correlate significantly with growth. After Blalock-Taussig operation, the ipsilateral pulmonary artery predominantly increased in size without significant growth of PVR and PT. Brock operation and enlargement of the right ventricular outflow tract with ECC, improving the flow in the pulmonary vascular system centrally, induced a significant, symmetrical growth of the pulmonary vascular system and, therefore, are our methods of choice for palliation in patients with tetralogy of Fallow combined with hypoplastic pulmonary arteries.

Adolescent↗
PubMed1984

The treatment of tetralogy of Fallot: early repair or palliation?

Between 1974 and 1983, 380 consecutive patients with tetralogy of Fallot underwent surgery. In 73 patients, undergoing palliative surgery, the operative mortality and late mortality was 6.8%. Twenty-five of these patients have undergone subsequent complete repair, while 38 are awaiting correction. During the last 4 years we preferred operative procedures with enlargement of the right ventricular outflow tract (80%) to shunt operations (20%). In contrast to shunts, enlargement of the outflow tract induces a symmetrical growth of hypoplastic pulmonary arteries without the risk of acquired pulmonary atresia or peripheral stenosis at the site of anastomosis. Three hundred twenty-nine patients have undergone repair. In 101 patients, who had palliative operations before complete repair, the operative mortality was 12.9% and late mortality 2.9%. Those patients undergoing repair as a first operation had an operative mortality of 8.8%, and a late mortality of 1.3%. In the last 5 years the operative mortality for all patients, whether or not they had had previous palliative surgery, was 4.7%. The incidence of transannular outflow tract patching was not greater in children less than 2 years of age (16.9%) than in older children, 2 to 14 years of age (16.5%). However, in our experience the requirement for subvalvular outflow patches was higher in younger children (52.1%) than in the older children (34.1%). Because of this high incidence, particularly in younger patients, we have now begun to repair tetralogy of Fallot using the transatrial approach, thus reducing our use of subvalvular patches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗